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Notes from the International Society of Hair Restoration Surgery, July 22- 26, 2009 in Amsterdam
The 17th Annual Scientific Meeting of the International Society of Hair Restoration Surgery was held at the RAI Congress Centre in Amsterdam, the Netherlands on 22-26 July 2009. Hundreds of physicians, primarily hair transplant surgeons, were in attendance listening to presentations and viewing demonstrations from pioneers and leaders in the field of hair restoration. Although the focus of the meeting was predominantly surgical, there were gems of information in regards to the medical treatment of alopecia androgenetica, now more correctly referred to as male or female pattern hair loss (MPHL or FPHL).
Ken Washenik, MD, PhD is Chief Medical Officer and Medical Director of Bosley and President of the North American Hair Research Society. He confirmed that topical minoxidil does promote hair growth in the frontal region of the scalp and is only slightly less effective than at the vertex. The figures given for a 5% minoxidil solution were a success rate of 54% at the vertex and 51% at the frontal region. The general perception that topical minoxidil doesn’t treat frontal hair loss was largely due to the wording of the packaging for Rogaine, which says topical minoxidil is for 'growing hair at the vertex'. Understandably, Upjohn did not include statistics for frontal hair growth to the FDA, when it applied for an approval. So, the FDA required Upjohn to state that Rogaine is to be used to 'grow hair at the vertex". It is the temporal regions of the scalp, which are the most resistant to treatment for MPHL. Although the exact mechanisms by which minoxidil promotes hair growth is still not completely understood, Dr. Washenik offered evidence that minoxidil acts as a vascular endothelial growth factor and stimulates prostaglandins, which may modify the inflammatory response.
Won-Soo Lee, MD, PhD is a Professor of Dermatology at the Yonsei University Wonju College of Medicine and was the leader of the team that conducted the Phase III Clinical Trials on the ‘Effect of Dutasteride on Male Pattern Baldness’. This was a randomized, double blind, placebo controlled, parallel group, multicenter study. One hundred fifty three men, 22 to 49 years old, were randomized to receive dutasteride 0.5mg or placebo daily for 24 weeks. After 24 weeks of drug administration, all subjects were followed up for an additional four months. Conclusion: “This study demonstrated that dutasteride 0.5mg/day administered for six months was well tolerated and slowed the progression of hair loss and increased hair growth in Korean men with MPB.”
When asked, Dr. Won-Soo Lee could not give a reason why Glaxo delayed such clinical trials for seven years or why the limited trials took place in Korea, except to note that Glaxo did not consider Phase III trials for dutasteride in the treatment of MPB to be a high priority in the company’s Research and Development and that Korea is an emerging economy and might be a potentially big market.
During the brief Q & A session following the talk, Dr. Won-Soo Lee was asked about the potential dangers of dutasteride, which passes the blood-brain barrier, but did not receive an answer. Another in the audience asked if sperm counts were performed on the subjects in the Phase III Clinical Trials. They were not. The doctor who asked the question had three patients who were taking dutasteride for MPB. Two of the three had ‘severely reduced’ sperm counts and in one of the two patients sperm was not detectable.
It has been known for a long time that minoxidil works on the potassium channels with increased vascular flow. Nilofer P. Farjo, MBChB, ABHRS, FIT of the Farjo Medical Centre, Manchester, United Kingdom investigated whether ATP sensitive potassium channels were present in the human hair follicle and concluded that dermal papillae contain K+ATP channels that respond to minoxidil and that it may be possible to develop novel drugs specifically to target these same channels with greater efficacy or to target the potassium channels to which minoxidil does not bind.
Another speaker from the Farjo Medical Centre in Manchester, United Kingdom, Bessam Farjo, has been studying Prostaglandin Receptors in Scalp Hair Follicles. Prostaglandins regulate a wide range of physiological functions, but their role in hair growth is unknown. Interest in prostaglandins as related to hair growth was peaked when a prostaglandin F2a analogue, latanoprost, used as a treatment for patients with glaucoma stimulated eyelash growth as a side effect. Perhaps a better understanding of the mechanism of action of prostaglandin F2a may lead to the development of future treatments for hair loss.
Alan J. Bauman, MD. D.A.B.H.R.S., founder and medical director of Bauman Medical Group presented a talk of the ‘FDA Approval of Bimatoprost for Eyelash Growth’, which occurred in December 2008. Bimatoprost (Latisse) is effective in stimulating eyelash growth, but its’ use in the treatment of MPB is not practical. It requires a ten-fold increase in the concentration of bimatoprost (Latisse) to achieve the same effect as a 5% minoxidil solution and the cost would be prohibitive as the average cost of Latisse is US$130 for 3mL of a 0.03% solution.
Undoubtedly, the most amusing and entertaining presentation was given by D. Hugh Rushton, PhD, BA, FIT from the University of Portsmouth, United Kingdom, who has been a leading hair researcher for over 35 years. His talk was on an ‘Overview of OTC Products’. Over the Counter hair care products account for 3.3 billion dollars in the U.S. per year. Hair loss can adversely affect an individual’s quality of life and many vulnerable individuals desperately seek a cure for their hair loss. While medical treatments have proof of efficacy, the most striking feature associated with OTC hair loss products is a lack of any objective evaluation. Instead, they incorporate ‘right sounding’ scientific terminology, pay celebrities or sports figures for endorsements and prominently display ‘before and after’ photographs, which may or may not have been manipulated, to induce individuals to buy their products.
In his discussion of the HairMax LaserComb by Lexington International, Dr. Rushton reviewed the studies that are posted on Hair Loss Treatment, Laser Hair Therapy, Laser Hair Regrowth, Hair Loss, Hair Growth Laser, Laser Brush, Reverse hair loss, Hair Restoration for men, Thinning hair and noted that the conclusions were based on faulty data. For example, the diameter of the circular tattoo on scalp in the six-month photograph is larger than on the baseline photograph and the tattoo itself was darker than in the baseline photograph, whereas the pigments in the tattoo would have been expected to dissipate. In addition, the hairs within the tattoo were cut short in the baseline photograph, but not in the ‘after’ photograph, giving the impression of more hair.
An afternoon session on Low Level Laser Therapy was moderated by Robert T. Leonard, Jr., DO. In 1967 a few years after the first working laser was invented, Endre Mester in Hungary decided to test if laser radiation might cause cancer in mice. He shaved the hair off their backs, divided them into two groups and gave a laser treatment with a low powered ruby laser (694-nm) to one group. They did not develop cancer and to his surprise the hair on the treated group grew back more quickly than the untreated group. This was the first demonstration of “laser biostimulation”. Since then, medical treatment with coherent-light sources (lasers) or noncoherent light (light emitting diodes, LEDs) has been extensively studied in experimental and clinical investigations, but remains somewhat controversial. It’s probably safe to say that laser treatments for pattern hair loss can be beneficial when it’s performed under strict clinical conditions, but there is still skepticism in regards to the laser devices for home use.
The International Society of Hair Restoration Surgery is, of course, primarily interested in the surgical aspects of hair restoration, so the medical treatment of pattern baldness was limited to the only currently approved FDA medications, i.e. topical minoxidil and finasteride. Hopefully, there will be information in regards to new medications and current clinical trials at the 6th World Congress for Hair Research 16-19 June 2010 at the Cairns Convention Centre, Cairns, Australia.
The 17th Annual Scientific Meeting of the International Society of Hair Restoration Surgery was held at the RAI Congress Centre in Amsterdam, the Netherlands on 22-26 July 2009. Hundreds of physicians, primarily hair transplant surgeons, were in attendance listening to presentations and viewing demonstrations from pioneers and leaders in the field of hair restoration. Although the focus of the meeting was predominantly surgical, there were gems of information in regards to the medical treatment of alopecia androgenetica, now more correctly referred to as male or female pattern hair loss (MPHL or FPHL).
Ken Washenik, MD, PhD is Chief Medical Officer and Medical Director of Bosley and President of the North American Hair Research Society. He confirmed that topical minoxidil does promote hair growth in the frontal region of the scalp and is only slightly less effective than at the vertex. The figures given for a 5% minoxidil solution were a success rate of 54% at the vertex and 51% at the frontal region. The general perception that topical minoxidil doesn’t treat frontal hair loss was largely due to the wording of the packaging for Rogaine, which says topical minoxidil is for 'growing hair at the vertex'. Understandably, Upjohn did not include statistics for frontal hair growth to the FDA, when it applied for an approval. So, the FDA required Upjohn to state that Rogaine is to be used to 'grow hair at the vertex". It is the temporal regions of the scalp, which are the most resistant to treatment for MPHL. Although the exact mechanisms by which minoxidil promotes hair growth is still not completely understood, Dr. Washenik offered evidence that minoxidil acts as a vascular endothelial growth factor and stimulates prostaglandins, which may modify the inflammatory response.
Won-Soo Lee, MD, PhD is a Professor of Dermatology at the Yonsei University Wonju College of Medicine and was the leader of the team that conducted the Phase III Clinical Trials on the ‘Effect of Dutasteride on Male Pattern Baldness’. This was a randomized, double blind, placebo controlled, parallel group, multicenter study. One hundred fifty three men, 22 to 49 years old, were randomized to receive dutasteride 0.5mg or placebo daily for 24 weeks. After 24 weeks of drug administration, all subjects were followed up for an additional four months. Conclusion: “This study demonstrated that dutasteride 0.5mg/day administered for six months was well tolerated and slowed the progression of hair loss and increased hair growth in Korean men with MPB.”
When asked, Dr. Won-Soo Lee could not give a reason why Glaxo delayed such clinical trials for seven years or why the limited trials took place in Korea, except to note that Glaxo did not consider Phase III trials for dutasteride in the treatment of MPB to be a high priority in the company’s Research and Development and that Korea is an emerging economy and might be a potentially big market.
During the brief Q & A session following the talk, Dr. Won-Soo Lee was asked about the potential dangers of dutasteride, which passes the blood-brain barrier, but did not receive an answer. Another in the audience asked if sperm counts were performed on the subjects in the Phase III Clinical Trials. They were not. The doctor who asked the question had three patients who were taking dutasteride for MPB. Two of the three had ‘severely reduced’ sperm counts and in one of the two patients sperm was not detectable.
It has been known for a long time that minoxidil works on the potassium channels with increased vascular flow. Nilofer P. Farjo, MBChB, ABHRS, FIT of the Farjo Medical Centre, Manchester, United Kingdom investigated whether ATP sensitive potassium channels were present in the human hair follicle and concluded that dermal papillae contain K+ATP channels that respond to minoxidil and that it may be possible to develop novel drugs specifically to target these same channels with greater efficacy or to target the potassium channels to which minoxidil does not bind.
Another speaker from the Farjo Medical Centre in Manchester, United Kingdom, Bessam Farjo, has been studying Prostaglandin Receptors in Scalp Hair Follicles. Prostaglandins regulate a wide range of physiological functions, but their role in hair growth is unknown. Interest in prostaglandins as related to hair growth was peaked when a prostaglandin F2a analogue, latanoprost, used as a treatment for patients with glaucoma stimulated eyelash growth as a side effect. Perhaps a better understanding of the mechanism of action of prostaglandin F2a may lead to the development of future treatments for hair loss.
Alan J. Bauman, MD. D.A.B.H.R.S., founder and medical director of Bauman Medical Group presented a talk of the ‘FDA Approval of Bimatoprost for Eyelash Growth’, which occurred in December 2008. Bimatoprost (Latisse) is effective in stimulating eyelash growth, but its’ use in the treatment of MPB is not practical. It requires a ten-fold increase in the concentration of bimatoprost (Latisse) to achieve the same effect as a 5% minoxidil solution and the cost would be prohibitive as the average cost of Latisse is US$130 for 3mL of a 0.03% solution.
Undoubtedly, the most amusing and entertaining presentation was given by D. Hugh Rushton, PhD, BA, FIT from the University of Portsmouth, United Kingdom, who has been a leading hair researcher for over 35 years. His talk was on an ‘Overview of OTC Products’. Over the Counter hair care products account for 3.3 billion dollars in the U.S. per year. Hair loss can adversely affect an individual’s quality of life and many vulnerable individuals desperately seek a cure for their hair loss. While medical treatments have proof of efficacy, the most striking feature associated with OTC hair loss products is a lack of any objective evaluation. Instead, they incorporate ‘right sounding’ scientific terminology, pay celebrities or sports figures for endorsements and prominently display ‘before and after’ photographs, which may or may not have been manipulated, to induce individuals to buy their products.
In his discussion of the HairMax LaserComb by Lexington International, Dr. Rushton reviewed the studies that are posted on Hair Loss Treatment, Laser Hair Therapy, Laser Hair Regrowth, Hair Loss, Hair Growth Laser, Laser Brush, Reverse hair loss, Hair Restoration for men, Thinning hair and noted that the conclusions were based on faulty data. For example, the diameter of the circular tattoo on scalp in the six-month photograph is larger than on the baseline photograph and the tattoo itself was darker than in the baseline photograph, whereas the pigments in the tattoo would have been expected to dissipate. In addition, the hairs within the tattoo were cut short in the baseline photograph, but not in the ‘after’ photograph, giving the impression of more hair.
An afternoon session on Low Level Laser Therapy was moderated by Robert T. Leonard, Jr., DO. In 1967 a few years after the first working laser was invented, Endre Mester in Hungary decided to test if laser radiation might cause cancer in mice. He shaved the hair off their backs, divided them into two groups and gave a laser treatment with a low powered ruby laser (694-nm) to one group. They did not develop cancer and to his surprise the hair on the treated group grew back more quickly than the untreated group. This was the first demonstration of “laser biostimulation”. Since then, medical treatment with coherent-light sources (lasers) or noncoherent light (light emitting diodes, LEDs) has been extensively studied in experimental and clinical investigations, but remains somewhat controversial. It’s probably safe to say that laser treatments for pattern hair loss can be beneficial when it’s performed under strict clinical conditions, but there is still skepticism in regards to the laser devices for home use.
The International Society of Hair Restoration Surgery is, of course, primarily interested in the surgical aspects of hair restoration, so the medical treatment of pattern baldness was limited to the only currently approved FDA medications, i.e. topical minoxidil and finasteride. Hopefully, there will be information in regards to new medications and current clinical trials at the 6th World Congress for Hair Research 16-19 June 2010 at the Cairns Convention Centre, Cairns, Australia.
